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ENT Flashcards

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1
Q

What are the different forms of audiometry, and outline what they assess and how

A

Pure tone audiometry
Assesses bone conduction threshold at different sound frequency and volumes

Tympanometry
Evaluates middle ear function by assessing tympanic membrane stiffness

Evoked response audiometry
Used for neonatal screening by measuring brain response to an auditory stimulus

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2
Q

Outline the presentation of otitis externa

A

Watery discharge
Itch
Pain and tragal tenderness

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3
Q

What are some causes and common infective agents in otitis externa?

A

Moisture
Trauma
Absence of wax
Hearing aid

Most commonly pseudomonas infection but also Staph aureus

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4
Q

What is the management of otitis externa?

A

Ear drops - betamethasone + neomycin or gentamycin

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5
Q

What is malignant otitis media and who gets it?

A

Life threatening infection which may cause skull osteomyelitis presenting in diabetics with severe otalgia esp at night, granulation tissue in the canal and copious otorrhoea

Surgical debridement with IV abx

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6
Q

What is bullous myringitis?

A

Painful haemorrhagic blisters on deep meatal skin and TM associated with influenza infection

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7
Q

What is the clinical presentation of TMJ dysfunction?

A

Ear and facial ache
Joint clicking/popping
Bruxism
Jointline tenderness

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8
Q

What are the Ix and Rx for TMJ dysfunction?

A

MRI
NSAIDs
Stabilising orthodontic occlusional prostheses

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9
Q

What is the classification of otitis media?

A

Acute
Otitis media with effusion - after symptom regression
Chronic - >3 months
Chronic suppurative OM - discharge with hearing loss and evidence of central drum perforation

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10
Q

Which organisms commonly cause otitis media?

A

Pneumococcus
Haemophilus

Viral
Moraxella

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11
Q

What is the typical presentation of otitis media?

A 
Children post viral URTI
Rapid onset ear pain
Irritability, anorexia, vomiting
Purulent discharge if perforation
Fever
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12
Q

What is the treatment of acute otitis media/

A

Paracetamol

Amoxicillin

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13
Q

What are the complications of acute otitis media?

A

Intratemporal - OME, perforation, mastoiditis, facial nerve palsy

Intracranial - menin/encephalitis, brain abscess, sub/epidural abscess

Systemic - bacteraemia, septic arthritis, IE

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14
Q

How does otitis media with effusion typically present?

A

Inattention at school
Poor speech development
Hearing impairment

O/E
Retracted dull TM with fluid level

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15
Q

What is the investigation and management of otitis media with effusion?

A

Typanometry

Usually sel limiting but consider grommets if persistent hearing loss

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16
Q

What is the presentation of chronic suppurative OM?

A

Painless discharge with hearing loss

TM perforation

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17
Q

Management of chronic suppurative OM?

A

Aural toilet

Abx/steroid drops

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18
Q

Qhat is the main complication of chronic suppurative OM?

A

Cholesteatoma

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19
Q

What is the pathology and presentation of mastoiditis?

A

Middle ear inflammation causing destruction of mastoid air cells and abscess formation

Fever
Mastoid tenderness
Protruding auricle

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20
Q

Imaging modality for mastoiditis?

A

CT

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21
Q

Rx for mastoiditis?

A

IV Abx

Myringotomy +- mastoidectomy

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22
Q

What is a cholesteatoma, and what are the two types?

A

A locally destructive expansion of stratified squamous epithelium in the middle ear

Congenital
Acquired (2ary to attic perforation in chronic suppurative OM)

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23
Q

How does a cholesteatoma typically present?

A

Foul smelling white discharge with headache and CN 5, 7 and 8 involvement

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24
Q

Complications for cholesteatoma?

A

Deafness
Meningitis
Abscess

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25
What are the causes of tinnitus?
``` Specific Menieres Acoustic neuroma Otosclerosis Noise induced Injury Presbyacusis ``` General - HTN, anaemia ``` Drugs - Aspirin Aminoglycosides Loop diuretics EtOH ```
26
How might the history of tinnitus point you to the cause?
Character; constant, pulsatile Unilateral - ac neuroma FHx - otosclerosis Vertigo/deafness - ac neuroma, Meniere's
27
Aside from audiometry, what Ix should be done for patients with unilateral vertigo and why?
MRI for CPA malignancy
28
Rx of tinnitus?
Treat the cause Psych support Hypnotics
29
What are the causes of vertigo?
Vestibular Menieres, BPPV, labyrinthitis Central Neuroma, MS, vertebrobasilar insufficiency, injury, inner ear syphillis Drugs - Gentamicin, loops, metronidazole, co-trimoxazole
30
What investigations would you do in a vertigo patient?
``` Hearing CN exam Cerebellum and gait Romberg (+ve indicates vestibular or proprioception) Hallpike manouvre Audiometry, calorimetry, LP, MRI ```
31
What is the underlying pathology in Meniere's disease?
Dilatation of endolymph spaces of membranous labyrinth
32
What is the presentation of Meniere's disesae?
``` Attacks of vertigo occuring in clusters lasting up to 12 hours Progressive SNHL Vertigo and N/V Tinnitus Aural fullness ```
33
What is the key investigation finding seen in Meniere's disease?
Audiometry showing low frequency SNHL which fluctuates
34
Management of Meniere's disesae?
Medical Cyclizine, betahistine for vertigo Surgical Gentamicin instillation via grommets Saccus decompression
35
How does viral labyrinthitis present and how is it managed?
Following febrile URTi with sudden vomiting and severe vertigo exacerbated by head movement Cyclizine
36
Whgat is the pathology and presentation of BPPV?
Displaced otoliths in the semicircular canals commonly after head injury. Presents with sudden rotational vertigo for <30 seconds provoked by head turning, with nystagmus
37
What is the positive investigation finding in BPPV?
Positive Hallpike manouvre with upbeat torsional nystagmus
38
How is BPPV treated?
Self limiting Epley manouvre Betahistine
39
What is the site of conductive hearing loss?
Anywhere between the auricle and round window
40
What are some causes of conductive hearing loss in adults?
Obstruction - wax, pus, FB TM perf - trauma, infection Ossicles - otosclerosis, infection, trauma Inadequate Eustacian tube ventilation of the middle ear
41
What is the site of SNHL?
Dochlea Cochlear nerve Brain
42
What are some causes of SNHL in adults?
Drugs - Aminoglycosides, vancomycin Post infective - meningitis, measles, mumps, herpes Misc - Menieres, trauma, MS, CPA lesion, low b12
43
With which syndrome is ac neuroma associated/
NF2
44
How would an acoustic neuroma present?
Slow onset unilateral SNHL with tinnitus and or vertigo Headache (due to raised ICP) 5,7,8 palsies Cerebellar signs
45
What differentials might you have for an ac neuroma?
Meningioma Cerebellar astrocytoma Mets
46
What is the inheritance pattern of otosclerosis?
AD with fixation of the stapes at the oval window
47
How does otosclerosis present and when?
Begins in early adult life with bilateral conductive deafness and tinnitus HL improved in noisy places (Willis' paracousis) Worsened by pregnancy, menopause and menstruation
48
What are the congenital causes of conductive hearing loss in children?
Structural anomalies Congenital cholesteatoma Pierre-Robin
49
What are the congenital causes of SNHL in children?
``` AD - Waardenburgs AD - Alports (+haematuria), Jewel Lange Nielson (+long QT) Xlinked - Alports INfections - CMV, rubella, HSV, toxo Ototoxic drugs ```
50
What is the management of a cauliflower ear?
Aspiration + firm packing
51
What is Exostoses?
Smooth symmetrical bony narrowing of the internal ear canals due to cold exposure, resulting in conductive hearing loss
52
What is the pathology of allergic rhinosinusitis?
T1HS IgE mediated inflammation from allergen exposure leading to mediator release from mast cells
53
How would you investigate rhinosinusitis?
Skin prick testing | RAST tests
54
What is the management of allergic rhinosinusitis?
Allergy avoidance 1. Antihistamine or beclometasone nasal spray 2. IN steroids + antihistamines 3. Zafirlukast 4. Immunotherapy
55
What are the causative agents of acute and chronic sinusitis?
Acute - Pneumococcus, Haemophilus, Moraxella | Chronic - Staph, anaerobes
56
What are the causes of sinusitis?
``` Mostly following viral illness Some 2ary to dental root infections Swimming in infected water Anatomical susceptability Systemic disease e.g. Kartageners ```
57
What are the clinical features of sinusitis?
``` Pain Discharge (-> post nasal drip) Nasal obstruction Anosmia ?fever ```
58
What is the management of acute sinusitis?
``` Bed rests decongestants analgesia nasal douching topical steroids Abx generlaly not used ```
59
What is the mnagement of chronic/recurrent sinusitis?
Stop smoking Fluticasone spray Functional endoscopic sinus surgery
60
What are the complications of sinusitis?
Mucoceles Orbital cellulitis Osteomyelitis CNS infection
61
What are the featuers of a nasal polyp?
``` Watery rhinorrhoea Purulent post nasal drip Nasal obstruction Sinusitis Headaches Snoring ```
62
What are some of the associations of nasal polyps?
Rhinitis CF Aspirin hypersensitivity Asthma
63
What might a single unilateral polyp indicate?
Malignancy
64
What is the management of nasal polyps?
Betametasone drops | Endoscopic polypectomy
65
What important checks must be done in a nasal #?
Teeth malocclusion and diplopia
66
WHat is the management of a fractured nose?
Exclude septal haematoma Rexamine after 1 week Reduce under GI with post op splinting within 2 weeks
67
What is the danger and management of a septal haematoma?
Septal necrosis and nasal collapse if untreated Boggy swelling and nasal obstruction Needs evacuation under GA with packing and suturing
68
What are the common causes of epistaxis?
``` Unknown Trauma Local infection Pyogenic granuloma (overgrowth of tissue on littles area) Osler Weber Rendu Coagulopathy Neoplasm ```
69
What is little's area/Kiesselbach's pleuxs?
An area on the anterior nasal septum where ethmoid and other arteries anastamose
70
Initial management of epistaxis?
Assess for shock Sit up head tilted down, compress nasal cartilage for 15 minutes If bleeding not controlled remove clots by suction or blowing to try to visualise the bleed
71
Management of anterior epistaxis?
Usually at Little's area Insert gauze soaked in vasoconstrictor and local anaesthetic for 5 mins Can use silver nitrate sticks for cautery Merocel pack for persistent bleeds
72
Advice for after the bleed
``` Dont pick nose sit upright and out of sun Avoid bending or lifting Sneeze through mouth No hot food or dtrink Avoid drink and tobacco ```
73
What are the features and inheritance pattern of HHT?
AD inheritance Mucosal telangiectasia Internal telangiectasiae and AVMs (lungs, liver, brain) Rarely pulmonary HTN and colon polyps which may progress to cancer.
74
Where is the jugulodigastric node?
Midway down the anterior border of sternocleidomastoid
75
What organism must be considered in tonsillitis?
EBV
76
What are the Centor criteria and how is it interpreted?
``` 1 point each for Absence of cough Fever Tonsillar exudates Tender anterior cervical adenopathy ``` 0-1 no Abx 2 consider rapid Ag test 3 or more - Abx indicated
77
Why should amoxicillin not be used for tonsilitis?
It causes a severe mac Pap rash in EBV
78
What are the indications for tonsillectomy?
Recurrent cases Airway obstruction Quinsy (peritonsillar abscess) Ca suspicion
79
What are the potential complications of a tonsillectomy?
Reactive haemorrhage | Tonsillar gag may damage teeth or TMJ
80
What are the complications of strep throat?
``` Quinsy Retropharyngeal abscess Lemierre's syndrome Scarlet fever Rheumatic fever Post strep glomerulonephritis ```
81
What are the features of quinsy?
``` Trismus - lock jaw Odonophagia - unable to swallow saliva Halitosis Tonsillitis - unilateral Contralateral uvula displacement Cervical lymphadenopathy ```
82
What is the management of quinsy?
ADMIT | IV Abx
83
What is Samter's triad?
Nasal polyps Asthma Aspirin hypersensitivity
84
What is Lemierre's syndrome?
IJV thrombophlebitis with septic embolization most commonly affecting the lung Caused by Fusiform necrophorum
85
What are the functions of the larynx?
Phonation Positive thoracic pressure Respiration Prevention of aspiration
86
What are the features of laryngitis?
Pain, hoarseness, fever with redness and swelling of the vocal cords
87
Laryngeal papilloma is secondary to which viral infection, and how does it present?
HPV Kids with scratchy voices
88
What are the symptoms of a recurrent laryngeal nerve palsy?
Hoarseness Breathy voice with bovine cough Repeated coughing from aspiration Exertional dyspnoea due to narrowed glottis
89
What are the causes of laryngeal nerve palsy?
30% local cancers 25% iatrogenic (para-/thyroidectomy, carotid endarterectomy Aortic aneurysm Bulbar palsy
90
What is the classic presntation of laryngeal SCC?
Male smoker and drinker presents with dys/odynophagia and hoarsenss progresisng to stridor with weight loss
91
What are patients who have had laryngeal SCC left with?
Trachy with speech valve
92
What is the presentation of laryngomalacia in children?
Floppy aryepiglottic folds and glottis causing laryngeal collapse on inspiration Stridor early + positional
93
What agents cause epiglotitis in children and how does it presnet?
GAS Sudden onset Continuous stridor Drooling Toxic
94
Treatment of epiglottitis?
``` Do not examine throat Consult anaesthetics and ENT surgeons 02 + adrenaline nebs IV dex Cefotaxime Intubate IN THEATRE ```
95
What are the possible complications following Bell's palsy?
Synkinesis - blinking causes oral upturning | Crocodile tears - eating stimulates unilateral lacrimation rather than salivation
96
What is the typical presentation of Ramsay Hunt syndrome?
Preceding ear pain/stiff neck Vesicular rash in auditory canal Ipsilateral facial weakness, ageusia, hyperacusis May affect CN7 as well
97
Rx of Ramasy Hunt?
Valaciclovir and prednisolone within 72 hours
98
What are the differentials for a facial nerve palsy?
``` Bells - non forehead sparing Ramsay Hunt - rash Cholesteatoma - discharge Otitis media Parotid tumour Trauma Peripheral neuropathy ```

Scott's Notes (21 decks)

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